#2695 of 11K

J7296

Levonorgestrel intrauterine contraceptive system insertion

Levonorgestrel intrauterine contraceptive system insertion is the #2,695 most-billed Medicaid procedure code, with $4.1M in payments across 5K claims from 2018–2024. The national median cost per claim is $860.31.

Total Paid

$4.1M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$809

National Cost Distribution

How much do providers bill per claim for J7296? Based on 27 providers billing this code nationally.

Median

$860.31

Average

$781.59

Std Dev

$319.75

Max

$1,588.49

Percentile Distribution (Cost per Claim)

p10

$363.37

p25

$556.70

Median

$860.31

p75

$925.36

p90

$1,078.10

p95

$1,218.55

p99

$1,495.85

50% of providers bill between $556.70 and $925.36 per claim for this code.

90% bill between $363.37 and $1,078.10.

Top 1% bill above $1,495.85.

About This Procedure

HCPCS code J7296 (Levonorgestrel intrauterine contraceptive system insertion) was billed by 28 providers across 5K claims, totaling $4.1M in Medicaid payments from 2018–2024. This code was used for 5K unique beneficiaries.

Fraud Risk Context

Injectable drug codes carry high per-claim costs and have been involved in drug diversion and upcoding schemes.

Source: HHS OIG Reports

Risk Assessment

Billing Statistics

Median Cost/Claim

$860.31

Providers Billing

National Spending

$4.1M

Avg/Median Ratio

0.91×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J7296

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1639267214	$1.0M	$1,186.74	1.4× median	Top 10%
2	1487749495	$638K	$1,005.67	1.2× median	Above 75th
3	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$637K	$910.03	1.1× median	Above Median
4	1760756860	$434K	$847.37	1.0× median	Below Median
5	1417959701	$240K	$377.28	0.4× median	Below Median
6	1730136680	$143K	$591.88	0.7× median	Below Median
7	1336174325	$137K	$932.64	1.1× median	Above 75th
8	1982798831	$136K	$846.44	1.0× median	Below Median
9	1285701672	$132K	$549.22	0.6× median	Below Median
10	1821095779	$124K	$523.61	0.6× median	Below Median
11	1629057146	$113K	$771.68	0.9× median	Below Median
12	1134100134	$51K	$860.31	1.0× median	Below Median
13	1699860999	$45K	$910.44	1.1× median	Above Median
14	1518039858	$40K	$881.64	1.0× median	Above Median
15	1043304769	$38K	$1,588.49	1.8× median	Top 1%
16	1073608675	$28K	$948.91	1.1× median	Above 75th
17	1538444005	$17K	$453.64	0.5× median	Below Median
18	1497780480	$16K	$1,232.18	1.4× median	Top 10%
19	1720217698	$16K	$342.50	0.4× median	Below Median
20	1639218548	$15K	$564.18	0.7× median	Below Median

Showing top 20 of 28 providers billing this code

Related Procedures

J7298$77.8M J7300$20.8M J7304$19.6M J7297$8.1M J7303$4.9M

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